Peers criticize Ebacc
In a debate initiated by Lib Dem President Baroness Sal Brinton Peers, including myself decried the drop in creative subjects taken at GCSE as a result of the the the Government's EBacc measures which focus on STEM not STEAM i.e. the arts are excluded with all the consequent impact on the creative industries and the skills they need to develop.
This is the debate.
This what I said
The dropping by AQA of the history of art A-level forms an important part of the worrying context of the debate today. AQA said in its briefing that, although it recognises the huge importance of the study of the history of art, in the process of developing and obtaining accreditation for its new A and AS-levels in history of art, it had concluded that the new qualifications, developed from the Government’s criteria, would be extremely challenging to mark as a result of the large number and specialist nature of the options creating major risks when it came to awarding grades safely. I interpret this to mean that AQA’s decision to drop history of art A-level was partly based on the fact that there were insufficient experienced examiners. This rightly had the Sunday Times art critic Waldemar Januszczak choking on his carpaccio.
The second reason appears to be the low number of students taking the subject. As AQA said, these issues are exacerbated in the context of very low student entry numbers for these key stage 5 qualifications. Why is that? As my noble friend said, since the introduction of the English baccalaureate, we have seen a decline in the take-up of creative subjects. I shall add only one fact and figure to my noble friend’s dismal facts and figures: 21% fewer arts GCSEs were taken in 2016 compared to 2010. The provision of creative subjects has fallen most significantly in schools with a higher proportion of pupils on free school meals. It is clear that despite assurances by successive Secretaries of State for Education, the introduction of the English baccalaureate has sent a clear message to schools, teachers, parents and students about which subjects are seen as of value. For the sake of completeness, I should add that AQA is adamant that this decision is not driven by commercial or financial factors.
There is great concern at the decision to drop this A-level. The Association of Art Historians has commented:
“The decision to withdraw History of Art at Key Stage 5 marks a considerable loss to young people’s access to—and understanding of—a range of different cultures, artefacts and ideas”.
It also said that the symbolic space,
“the subject occupies within the school system is also fundamental in developing awareness of art history at undergraduate level and beyond”.
It is that “beyond” that creative industry leaders, in all disciplines, are worried about. These industries are grappling with some real issues, particularly skills gaps and shortages. For example, several creative occupations are currently featured in the tier 2 Migration Advisory Committee’s shortage occupation list, which is for non-EEA recruits. One can only imagine how this will look if there is a hard Brexit. Universities specialising in creative industries are keen to recruit their students from the widest pool possible, because talent and skills in these industries are at a premium.
There can be no argument about the importance of our creative industries. They are celebrated for outstanding economic performance in addition to their contribution to the UK’s culture and soft power. The Prime Minister herself has recognised our creative industries are a key strategic sector. For example, the success of UK television and film production, highlighted in official government figures last week as one of the,
“best performing sectors of the UK economy”,
which has helped to,
“maintain growth in a time of post-Brexit vote uncertainty”,
is attributed not only to the tax breaks that the sector enjoys but to the skills and talent base for which it is internationally admired. We simply cannot afford to lose this.
We need therefore to ensure that our education system supports the sector and that a good range of relevant creative subjects are taught in schools. As the Creative Industries Federation’s recent paper on the possible impact of Brexit, mentioned by other noble Lords, points out:
“Long-standing skills shortages in the creative industries stem from inadequate training and provision at schools … Brexit will compound this problem … It is crucial that education and training policy is formulated with a proper understanding of the needs of industry”.
How will the creative industries flourish if creative subjects are elbowed out of the curriculum? These subjects are opening horizons and signposting to possible careers. They can accelerate learning, attainment and success in students following a more traditional academic structure—including the so-called sought-after STEM subjects. My noble friend referred to the Creative Industries Federation’s other paper last month on the creative education agenda, which recommended four matters to the Government. It has done us a service with those recommendations. First, it says:
“Drop the 90 per cent target … The EBacc should not be the headline assessment measure for schools, but used as part of Progress and Attainment 8”.
Head teachers would be able to offer creative subjects as part of a balanced curriculum and it would send a clear message that the wide variety of skills and knowledge that they represent are important to our economy and our society. Secondly:
“Limit ‘outstanding’ to schools that warrant it”,
a point made, I think, by the noble Baroness, Lady Nye, and my noble friend. It goes on:
“A school must teach at least one creative subject, in lesson time, in order to be eligible for an ‘outstanding’ rating”.
Thirdly:
“Audit the skills gap … The Department for Education should conduct a proper audit of the skills and education needed by the creative industries as part of an industrial strategy”.
Fourthly, and finally:
“Adopt proper careers advice … The Government should work with industry to launch a sustained national campaign demonstrating the range of jobs in the creative industries and the subjects that lead to them”.
These are all sensible proposals and should be adopted. I look forward to the Minister’s reply.
How Does London Become the new Silicon Valley?
I recently gave a speech at Kings College Student Think Tank on the subject of how London could develop into Silicon City .
Here's what I said
I am delighted to be here at the launch today to talk about tech and what we can do to make sure that London really becomes Silicon City. I would in fact like to see Silicon Nation!
will.i.am says “Tech is new Rock N’ Roll” . He also says London is the centre of the world. And of course he's right!
We are already doing well –after all the UK is generating more $1bn Unicorns than any other country in Europe. It is already the pre-eminent location worldwide for Fintech. Just five years after the launch of Tech City, venture capital into London is now 10 times higher than in 2010.
Tech firms in the capital secured almost $1.4billion in venture capital financing over the course of 2014, double the figure for 2013 and 10 times the figure of 2010. In just the first three months of 2015, the City’s tech companies secured more than $682million in VC financing. Over the next ten years the number of digital technology companies in London is expected to rise to 45,000 and create more than £12 billion of economic activity, according to research by Oxford Economics
Of the 17 UK tech unicorns, 13 are based in London. More than the total of Sweden and Germany put together.There was a 92% increase in new digital companies incorporated in Inner London between 2010-13. 251,590 are in digital employment across Inner London, more than any other city in the UK Over the next ten years there are expected to be 46,000 more digital jobs in London, according to research by Oxford Economics
London has become the FinTech capital of the world – With more people employed in the sector than any other city worldwide, standing at 44,000 (1,000 more than New York). London is a major hub for big data. There are an estimated 54,000 big data workers within 25 miles of London, compared to 57,000 for New York City and 98,000 for San Francisco/Silicon Valley
I had the privilege of launching the Manifesto of TechUk the body that represents the UK tech industry shortly before our General Election this year. It strongly reinforced and complements the Start up Manifesto from COADEC published shortly before and the Report "Connected Cities" from Jim O'Neil's City Growth Commission published in July.
All of them in their own way tackle a series of policy initiatives and developments which UK Tech companies perceive they need to take effect to enable them to grow and prosper in the UK in the context of what is a global digital revolution which we are all experiencing and which TechUk’s Presdent Jaecqueline de Rojas has described as “Irreversible and Unstoppable”. In each case they want to build on success.
In a non political way everyone is now singing from the same hymn sheet. Let me tell you why.
Access to Finance and Commercial Advice
First we need to ensure that Tech companies at every stage-start up and beyond have access to the Finance they need to grow and can stay in London. This has been the subject of a great deal of activity in the past 5 years
Over time UK start up Tech companies have a benefited from a range of Government investment and support schemes giving them access to early stage equity finance through the Government's Seed Enterprise Investment schemes. It's one of the most generous early stage tax breaks available anywhere in the world
Tech companies have also benefited from a range of Government investment and support schemes, including the Business Growth Fund, Enterprise Capital Funds (ECF)and the Enterprise Finance Guarantee (EFG),
It is in two stages of equity finance where we are behind Silicon Valley and Nasdaq in New York. Problem of business accessing finance to achieve scale. There is a danger of businesses moving to the US at this funding stage. A recent report by Sherry Coutu on Scale Up highlighted this saying: “There is a lack of follow-on capital in the UK, compounded by short term investor mind-sets”
In response the London Stock exchange has created the new High Growth Segment to encourage companies to list here which is having an impact. It has also developed the ELITE programme of structured engagement developing and supporting ambitious private companies through their next stage of growth.
(Partnered with Imperial College Business School) ELITE delivers a three part service of education, business support, mentoring and access to an ecosystem of professionals fostering growth Companies enter an 18-month programme to give them a mix of education, training and direct contact with Europe's financial and advisory community. Elite shows company management teams how to get access to the most suitable funding to help them grow, which could be VC investment, private equity or stock market flotation
As regards debt finance with very limited exceptions the banks are failing SME's and start ups. They are only really interested in established businesses.
But in different ways BgF (Business growth Fund) and BBB (the new British Business Bank) go some way to addressing these issues. since its launch in 2011, BgF has directly invested over £400m of growth capital in more than 70 British scale-ups, with more than £200m deployed in the past 15 months. The British Business Bank has invested almost £150 million in a number of growth finance funds and lenders in the UK scale-up sector
There is however the government backed Start up Loans company that has made 33,000 loans for start ups since 2012 amounting to £181 million. The average loan size is £5000.
The Start Up Loans Company was established in September 2012, when Lord Young identified that if self-employment was rooted in the British mentality and considered as a viable career path this would lead to increased job creation. Their mission is to ensure the provision of affordable finance, free mentoring and support for those who cannot obtain funding from alternative sources.
The Start Up Loans Company is supported by the British Business Bank, with a further £330 million of government funding confirmed. 51% of loans have been to the under 30’s.
Then there is Crowd funding is beginning to have a real impact. Loans through UK Crowd funding have hit the £2bn mark at the end of last year.
Nicola Horlick:
“Crowdfunding is all about cutting out the middle man and allowing small businesses to get the funding they need without banks taking a slice of their margins in fees from when firms take out business loans," she said. "For savers, these ventures offer the potential for much greater returns."
It is good that funds such as Funding Circle are receiving government support through the Business Finance Partnership scheme (BFP). But in the wake of British drone startup Zano's recent bankruptcy after heavy funding from Kickstarter questions are being asked about the crowd funding model.
There is more to be done however . There is no magic wand but we should be facilitating new entrants to the banking sector, including through public procurement policy, so that there is much more choice and variety of competitors in banking, in particular business banking .I hope that the many new challenger banks such as Metro, TSB etc now emerging will make a difference but it should be much easier to establish a new bank and to switch Bank accounts especially when the customer has an overdraft.
Public Funding
I was pleased to see in the recent Autumn Statement that that the science budget has been ring fenced and more ‘Catapult’ innovation and technology centres, essentially business innovation accelerators, will be rolled out. This kind of public support is crucial
Commercial Mentoring
There is also a need for more commercial mentoring and support for start ups quite apart from the finance. This includes backing not just micro businesses but individuals as well. We should be giving them more support at the so called “Friends and Family” stage. Some sectors like the British Fashion Councils New Gen programme which identifies talent and nurtures and mentors it towards commercial success are a model of how this can work.
I came across an innovative new business the other day called Entrepreneur First. Unlike accelerators and seedfunders like Techstars, Y Combinator and Wayra, although they have impressive track records, EF focuses on finding and funding talented individuals, not just promising companies and using Venture Partners to mentor them on a weekly basis. They say “It's only a matter of time before EF produces some seriously big tech companies, possibly even unicorns." as a result.
Universities
Of course there is a role as well for serious tech, creative and R&D inspiration and help for start ups and micro business and that is where universities with their ever increasing enterprise agendas often come in.
For instance I went to a presentation lat week about The Creative Exchange which is a collaboration between Lancaster University, Newcastle University and the Royal College of art, who bring expertise of their PhD students in digital design to assist micro businesses develop their ideas and meet practical challenges.I know you at Kings are part of Creative Works London in partnership with QMUL and others, also Funded by the AHRC
Thirty-eight London-based universities, colleges, museums, libraries and archives. They work with businesses who are interested in exploring areas such as entrepreneurial development, emerging markets, new ways of engaging London’s diverse audiences, and the development of digital resources and media content. Having seen the Google Campus in Shoreditch in full swing I know that can be a source for help and inspiration too.
Understanding how to access these great schemes and skills for individuals and micro businesses is crucial however and there is more that could be done by government, the tech hubs (Tech City /Tech North) LEP’s and government sponsored catapults in helping them navigate to where university partners can be found.
Skills
The talent available however is far below what we need. Start ups need a mixture of technical and creative skills to develop their new digital services.
The Tech UK manifesto says we need 1 million tech jobs to be filled by 2020 to keep up with demand.
I welcome the mandatory inclusion in the curriculum of coding/computer science from this September for 5-16 year olds, the first in the G20 Also welcome the involvement of the tech sector in Code Clubs. Now of course we have the Raspberry Pi zero for $5 so there’s no excuse for not getting started!
But even if the pipeline from schools and universities is finding the right talent ,. subsequent training and proper apprenticeships are hugely important. We need to increase the number of apprenticeships both post school and university and improve their quality
I don’t know how many of you are from overseas but that said we will still be reliant on the skills of overseas undergraduates and post graduates and we should welcome them. We shouldn’t chase unrealistic targets in trying to reduce in net migration at the expense of growth in the digital economy. We should remove students from our immigration targets given their temporary status. In particular too we need to go further and reinstatement of the post study work route visa.
Good news on one front however. Attracting the best and brightest tech talent to the UK got easier today as the Home Office has published renewed eligibility criteria for the Tech Nation Visa Scheme (Tier 1 Exceptional Talent).
Following the announcement of plans to revise the criteria on 16th October 2015, the visa route is now officially open for applications under the new eligibility criteria.
This route is now open to candidates, who although assessed against the same criteria, will be considered to have ‘Exceptional Promise.’ This aims to open the route to a broader base of aspiring talent from outside the EU.
We shouldn’t just be talking about skills for entrepreneurs/ start ups, what about the customer, the audience-whatever we like to call them? The Tech Uk manifesto urges that digital exclusion is tackled. We still have many families without access to a computer or to internet facilities at home. There is still a lack of universal digital skills in Britain. 23% of adults lack basic digital skills.
Norway/Sweden by contrast have 97% basic digital literacy. We need commitment by Government to fund the teaching of basic digital skills through initiatives like Martha Lane-Fox’s Doteveryone initiative and Go On UK the digital skills charity she founded to combat digital exclusion.
On skills still I am delighted that industry is becoming less male dominated. We should use all available skills and encourage young women to go into STEM subjects as well as young men.
I mentioned the President of TechUk, we also have a whole range of other prominent women in tech. Eileen Burbridge who is the UK Ambassador for Fintec, Sherry Coutu who I have mentioned and is an important angel investor, Nicola Mendelsohn the V-P of Facebook and Chair of the Creative Industries Council, and not least Baroness Joanna Shields, the former CEO and Chair of Tech City and is now the internet safety and security Minister.
Clusters
The TechUk manifesto clearly recognizes the importance of geographic and sectoral balancing of our economy . Correct when the Manifesto says tech economy “more geographically extensive than is often recognized”
And this leads to the importance of clusters. Tech City yes-with 15,000 startups last year and the year before.
70,000 people now employed there. The Tech sector has accounted for 30%of new London jobs since 2009.
But there are so many other places,
- Newcastle Silicon Shore,
- Liverpool with the Baltic Triangle
- Brighton’s so called Silicon Beach
- Dotforge in Sheffield
- Software City Sunderland
Yes Manchester, Edinburgh, Leeds, Bristol. Birmingham, and Bath all have creative and tech clusters of different kinds . The role of our World class universities like Kings and their networks and enterprise and spinout activities is crucial in delivering all of this.
But RSA's City Growth Commission chaired by Jim now Lord O’Neil took the view that too many of the UK’s urban areas outside London are failing to achieve their growth potential. Compared with London these cities are still weak economically. How can we strengthen our clusters?
That's where the Northern Powerhouse Strategy comes in with development of the city region/combined authorities developed from policies started under the last (Coalition) government. So far we have Liverpool and Sheffield City Regions and the West Midlands Greater Manchester Tees Valley and North East Combined Authorities.
The plan is to devolve more economic decision making to local areas and away from national government. Cities will have greater powers, especially over finance. Currently 90% of tax is collected by central government. That is going to change entirely by 2020 ands city regions will have entire control over their income and budgets by then.
And the Cities are thinking big : I recently spoke at a Conference entitled " Manchester: From Regional Hub to Global Incubator!"
We also need to ensure much better transport and digital connectivity between our Metro areas outside London for instance and hopefully the investment in Transpennine line will do this along with the creation of Transport for the North.
International/The EU
We are already the highest net exporter of computer and information services among the G7 countries and our tech/internet economy accounts for a greater percentage of GDP in the UK than in any other G20 country.
We need digital markets to remain open and to break down the barriers to E-commerce across the EU to create a genuine European Digital Single Market. That is high up the agenda of the EU
The tech sector want the UK to help drive the reforms that Europe needs to become more open, innovative and competitive. As a result an overwhelming majority of the tech industry want the uk to stay in the EU.
We should embrace TTIP the US/EU free trade agreement in the offing.
The Role of Creative Content
There were some areas however where in my view the tech UK Manifesto could have been more explicit.
As well as recognising the need to be at the forefront of the Digital Economy our tech industries ands start ups need to acknowledge the increasing convergence between platform and content or design, between tech and the creative industries. There is no doubt that each sector is increasingly making use of relevant skills in the other.
All this means of course that Intellectual property protection through copyright enforcement is a subject of increasing importance in the digital age both as to product design and creative content. Attracting investment becomes more uncertain and more unattractive without proper protection of this vital asset. Business models are changing rapidly but all to a greater or lesser extent depend on good IP protection.
Digital copyright infringement sanctions need to be enhanced in the digital space. There are other initiatives eg Follow the Money which we could to ensure that infringing websites do not benefit from advertising and credit card company agreements.
However, combating piracy and unlawful copying is not simply a matter for the law. In both our countries we need to combat the idea that copyright infringement is socially acceptable through education and we need to make sure that there are legal ways of accessing copyright works at reasonable cost. Initiatives like Creative Content UK by the creative industries and ISP’s are important
The key too is improved licensing. One of the most exciting developments is the creation of the U.K. Copyright Hub which is a portal by which copyright works of all kinds can be identified and then licensed. It will I hope develop into an international resource. But it needs funding by government to ensure this happens.
Realize I haven't addressed the fundamental question of our broadband infrastructure. Could talk for hours about this but I will resist the temptation!
Rural areas are still beset by slow speeds. Despite a £1.2 billion procurement programme, we are still a long way from universal high-speed broadband. As a report from the Commons public accounts committee (PAC) last March detailed, red tape and the monopoly position effectively occupied by BT have stymied the programme.
Or housing. The Standard recently highlighted the fact that we may be Silicon City with some massively growing businesses like money transfer World Remit or holiday firm Secret Escapes but they won’t be able to expand if there no where for them to live. So housing policy is vital. We should do much more to encourage the provision of mixed studio/office living space with special tax breaks.
Britain and China: A Creative Partnership : LSE Confucius Institute Lecture
All Party Group debates the future of pharmacy
I recently spoke on a Panel at the All Party Pharmacy Group on 11th September about the the Future of Pharmacy.
Here is what I said:
Pharmacy in Britain is an incredible resource. I am a fan of pharmacy. It is often able to respond quickly and effectively to the consumer/customer/patient and to the right incentives.
It's called community pharmacy and the best pharmacies really are part of the community.
Some 10% of the NHS budget, when considering drug costs is channeled through community pharmacists
In the UK there are over 47,0000 registered pharmacists and over 21,800 pharmacy technicians. Of which there were 38,867 registered pharmacists and 18,165 pharmacy technicians in England last year.
The NHS Business Services Authority reports show that there were 11,236 community pharmacies in England at 31 March 2012.
That means there has been an increase from 9,500 of 15.3 per cent since 2002-03.
This compares to 10,000 GP general practices in England.
Of these 11,236, 61% are owned by multiples, that is they are in a chain of five or more.
They dispensed some 885.0 million items annually across England compared to 566.3 million in 2002/3.
So we have had huge growth in number of pharmacies over the past few years particularly as a result of the scheme to encourage new pharmacies that offer 100 hours a week to open.
That growth won’t continue.
Student Numbers
As former chair of the School of Pharmacy I have a strong interest in this area.
The Centre for Work Force Intelligence (CfWI) has now published a report on pharmacy workforce and student numbers which shows that by 2040 there will be an over supply of pharmacists of between 11,000 and 19,000. They recommend a staged approach to managing these numbers.
There has been a huge increase in graduate numbers with the expansion of schools of pharmacy in England from 12 to 21 in between 1999 and 2009, with several more opening or due to open.
This is not just due to new school of pharmacy opening, but also an expansion in numbers by the established schools. For example, several universities have a campus in Malaysia which swells their final year cohort. For example, Nottingham have around 300 students there.
This means too many graduates coming through the system from both the new and established schools. The number of undergraduates at any one time has gone from 4200 in 1999 to over 9800 in 2009. In the 2011/12 academic year there were 10,951 pharmacy students and 3,104 entered MPharm programmes in England .
This not only places pressure on clinical placements and academic resource but on preregistration places in pharmacies These are wholly within the control of employers –despite the investment made by the DoH – and are becoming much more scarce. NHS pre-registration training positions are falling too.
So we have a major issue now with an over supply of graduates from our schools of Pharmacy.
How do we ensure that we have the right number? How do we ensure that the education they undertake and the debts that they incur gives them the clear prospect of employment
This is under debate. BiS and DoH are in discussion about how numbers can be regulated with HEFCE the GPhC the RPS and the schools of pharmacy. At the request of the government, The Higher Education Funding Council for England (HEFCE) and Health Education England (HEE) are consulting on the supply of pharmacy graduates in England.
The consultation started on 2nd September, 2013 and will run until the 15th November, 2013.The HEFCE/HEE joint consultation proposes three options:
- To continue to allow the market to determine the number of pharmacy graduates
- To introduce an intake control at each university for entrants to MPharm pharmacy programmes
- To create a break-point during study which enables some students to graduate with a Bachelor of Science degree and others to progress through further study to qualify as registered pharmacists
Which option do we chose given that the market seems not to be delivering an acceptable solution?
Controlling the entry numbers is the medical nursing and dentistry option. But who is going to do that and how?
Neither HEFCE nor GPhC appear to want to do this.
It might even be preferable rather than spreading pain across all schools to licence certain schools to deliver the MPharm and or the Bsc on the basis of quality. Could the GPhC take this on?
Even if a cap on student numbers were to be implemented tomorrow, there will still be a 5-6 year lag in the system.
As regards the actual content of the MPharm we have had an increasingly well qualified graduate population especially over the last 10 years.
The MPharm coursescould be even better.
A review conducted for Medical Education England proposed an integrated 5 year course including a much greater clinical content with a strong contribution from employers as the 5 years would include 2 practice placements.
Joint sign off by the HEI and the employer would be needed to graduate.
Past Initiatives
Currently however it is arguable they are over educated for what they do.
We need to use our pharmacists to better clinical effect particularly in primary care.
This is not to say that successive governments and the pharmacists themselves have lacked ambition .
Many of the initiatives taken involving pharmacy don’t get buy in from GP’s. For example the latest statistics available (28 June 2013) show that 90% of pharmacists can receive electronic prescriptions but only 10% of GP’s are in a position to prescribe this way.
Pharmacists have invested money in consulting rooms but many have yet to see a return.
Whether initiatives have been effective seems to depend on whether a service is centrally mandated or at local discretion.
Contrast centrally funded Advanced Services eg New Medicines Services and Medicines Use Reviews with Enhanced Services such as Obesity initiatives locally commissioned by CCGs and formerly by PCTs.
MUR’s were introduced in 2005 under the new contractual arrangement for pharmacy under the Labour Government-and far better in their impact than the GP’s equivalent -are conducted by community pharmacies. Compared to 2.1 million in 2011/12.
A total of 2.4 million Medicines Use Reviews (MUR) were conducted by community pharmacy contractors in England in 2011-12, compared to 2.1 million in 2010-11, an increase of 325,524 (15.4 per cent).
Enhanced services by contrast have been a great aspiration but how successful have they really been?
Local enhanced services –which are at the discretion of PCT’s/CCG’s have actually decreased. The number of local enhanced services provided by community pharmacies in 2011-12 decreased by 1,679 (5.4 per cent) to 29,283 since 2010-11
Of the twenty services commissioned by PCTs the most commonly commissioned services in 2011-12 were Stop Smoking (19.2 per cent), Supervised Administration (19.1 per cent), Minor Ailment Scheme (12.1 per cent) and Patient Group Direction (11.9 per cent).
So we need to be very careful about we fund and configure services for the future.
The Future
As AT Kearney’s recent study shows however the winds of change are blowing.
What it calls the five forces for change are on the way which will inevitably mean closure of significant numbers of pharmacies.
- Squeeze on healthcare budgets
- Intensifying competition
- Transformation of the supply chain
- Emergence of new alternative channels
- Demand for convenience and expertise
Kearney says that in the face of these forces pharmacies can build on their trusting relationships with customers to become a front line point of care.
Unless we invest wisely in community pharmacy now, and build intelligently on the heritage of NHS community pharmacy and GP practice and if too much future investment goes into bigger secondary institutions rather than truly local facilities we will not gain the advantages of the new technologies now being introduced in medicine and IT.
We need to recognize the people want much more control over their own health. They want information and professional advice and support to be able to make choices. The classic change from Klein’s Church to Garage model! How do we best deliver what is called self care?
Change is under way in the pharmacy already. The future is robots on the one hand for dispensing and diagnostics and other skilled preventive and medicines management roles on the other.
The fact is that with reduced budgets and generics pharmacists will have to focus on services rather than products.
Do we need in effect a new breed of apothecaries as suggested in a recent paper with a much stronger clinical role going beyond diagnostics and health checks?
In the end this will be good for patients and the pharmacy profession
Our current primary care system is not designed to deal effectively with public health issues. We need much greater emphasis on prevention. Despite the experience of Enhanced Services we need major action on Smoking, diabetes, hypertension.
We need much better ways too of dealing with minor ailments.
Then there is the management of long term conditions allied to supporting independent living at home. The demographics mean that more older people living longer. 50% of the population will be over 50 by 2024.
With scarce resource Medication Therapy Management (MTM) will become even more important. We need to find effective ways of supporting NICE’s Guidelines on Adherence
Research by Prof Rob Horne and Professor Nick Barber at the School of Pharmacy, UCL shows that 50% of medicines not being used to best effect.
Some regarded the MUR’s as little more than a chat.
So the New Medicines Service was introduced as a result of this UCL School of Pharmacy research in 2011 to help support patient taking a new medicine and involved pharmacists phoning patients a week after starting an new medicine to check that they are adherent.
Pharmacy could contribute greatly to all these issues as the so called Third Pillar of Health care.
The new RPS Faculty has the potential to be an important development for the profession. The RPS launched it earlier this year, and it is in essence an accreditation structure for the profession, allowing those in practice to develop their clinical skills and become recognized for their achievements.
This recognises that Propper and more clinical use of pharmacists could lead to a massive reduction in hospital admissions and the productivity savings the NHS desperately needs but seems unlikely to achieve.
For much of this pharmacists will need appropriate access to health records.
Much will depend on the ability to collaborate with GP’s.
Why does it seem that GP’s are so reluctant? Do GP’s want to be want to be the gateway for everything even for preventive health care, self care , minor ailments and medicines management for which pharmacists are ideally suited?
Pharmacists need to operate more more flexibility too.
The greater use of technicians and more flexible contracts instead of locums.
How about new pharmacist staffed Community Health Centres.
Maybe pharmacists should be given a more explicit out of hours role.
This all leads to the question of how much professional freedom we give to the pharmacists.
My view is that the pharmacist of the future with the developments underway in pharmacy education mean that pharmacists will be well able to undertake much more clinical responsibility and we must encourage it. I hope this will be in cooperation with GP’s.They crucially need to move with times too.
There are some positive signs here as I see that the head of the dispensing doctors association Richard West is very positive about the role that pharmacists can play in reducing GP workloads.
Lord C-J promotes Kurdistan/UK tourism
This is a speech I gave at a recent Iraqi-Kurdistan Tourism Infrastructure Development Conference at the BIS Conference Centre-a Reflection on 10 years of development.
It's a great pleasure to be involved with an event promoting Iraqi Kurdistan.I’ve been looking back over developments in the last 10 years now since I first went to the Iraqi Kurdistan region in 2004 and its incredible what progress political, economic and social has been made since then .
As a member of of the All Party Parliamentary for Iraqi Kurdistan it's been a pleasure promoting relationships between the Region and the UK.
I made a speech about my visit in the House of Lords shortly after I got back and it is instructive to contrast then and now:
Then I was driven through South Eastern Turkey having flown to Dyarbakir and it was was a relief to arrive at the border with Iraq after so many hours. Now there is a major new British designed Hawler (Erbil) International Airport with direct flights from all over Europe
Then I complained about the attitude displayed by Turkish soldiers towards Iraqi Kurds at the border with border guards describing my literature about agriculture and education as a “problem” because it mentioned the words “Iraqi Kurdistan” .
Now there are excellent political relationship too between Presidents and PM Barzani and President Gul and PM Erdogan. The PKK issue in Turkey is beginning to be resolved too with a cease fire declared by their leader Abdullah Öcalan and a peace settlement in sight.
Trade between Turkey and Kurdistan flows freely. Turkish companies are the largest direct inward investor in the Region . Turkey is becoming directly involved in oil and gas exploration in the region
Now thanks to the freetrade approach adopted by the KRG there is huge investment by Turkey itself growing at 6-8%. Kurdistan’s growth rate is reported at 12%. There is a growing consumer economy.
Erbil itself and the other major cities are transformed . New hotels and shopping malls have sprung up in the last 10 years.
There are major Oil and gas developments. There has been significant exploration and finds from a number of medium sized companies and now oil majors such as ExxonMobil and Chevron.
10 years ago I noted the progress that had been made in providing universal education at primary and secondary levels in Kurdistan even in the smallest village and in adult education too. Now Higher Education is flourishing .Education links with Britain are growing stronger by the year symbolized by recent visit from higher education minister David Willets. Recently 21 universities visited to explore ties.
In those days there were two separate government administrations . One run by the KDP and one by the PUK. Now and for some time there is a common democratically elected parliament with regular terms of office for government following elections and the Prime Ministership has rotated between the parties on two occasions. . The government of different parties and faiths continues to be a model of pluralism.
Now we see the maturing of parliamentary opposition too.
I talked then about the absolute need for a British consulate in Erbil. Now there is vastly better representation of British interests in Kurdistan. We take the Consulate General for granted but still await proper premises in downtown Erbil and still have major UK visa frustrations !
Then the British were conspicuous by their absence in helping with the economic development of Kurdistan and building commercial ties. Now particularly in the last three years British companies have begun to get stuck in and we have seen many British companies represented at the major trade fairs. In 2011 at the Erbil Trade Fair there were 89 delegates, including 20 exhibitors, the largest UK trade delegation to the region to date, in fact the largest non Ministerial business delegation to anywhere!
There are something which were true then and I am glad to say have endured throughout the ten years
Then I said that security in the Region in contrast to the rest of Iraq thanks to the continuing presence of the peshmerga was excellent and this fact should be recognised in FCO advice. This has continued to be the case - and the FCO stresses this fact in travel and trade advice. Iraqi-Kurdistan really is an island in a sea of instability.
Then I said they had built the makings of a religiously tolerant pluralistic democratic society. It was notable that many of the Chaldean Christians retreating from the bombs in Mosul were taking refuge in Iraqi Kurdistan. Now there is a wonderful diversity of culture even more than ever in Kurdistan with a vibrant Christian quarter in Erbil in particular. Now of course the Region is absorbing a whole new set of refugees from Syria. All these elements lay the grounds for a potentially hugely successful tourism industry in Kurdistan which could become not just regional but international in nature.
I have a friend in Kurdistan who is passionate about the preservation of its cultural heritage and get regular updates on developments!
Bayan has mentioned some amazing sites. I've only been to a few of them.
Some cities in Kurdistan go back 8000 years to the dawn of civilisation like the UNESCO protected citadel of Erbil.
There is the Assyrian aqueduct -the largest in the world built by Sennecherib in 700 BCE and the site of Alexander the Great's famous battle against Darius III the Persian Ruler at Gaugamela IN 331 BCE.
There are the extraordinary Yazidi temples at Lalish
There is so much to see.
Now it even appears that the Hanging Gardens were not in Babylon but in Northern Iraq!
Allied to the history -and we must never forget that part of that history are some of the recent tragedies during the Anfall under Saddam Husedsein's rule and the genocide at Halabja in particular, now recognized as such by Parliament -there-is Kurdistan's extraordinary scenery -the spectacular Zagros mountains and dramatic waterfalls.
The mountains will be the friends of Kurdish tourism I hope!
Every year the tourism infrastructure in terms of transport links and much better quality hotels and hospitality offer-and shopping!- has improved.
All this will I am sure lead to a huge growth in tourism in Kurdistan. I am a great believer in the power of tourism to generate economic growth and employment and spend time urging government to do more here to release the potential.
I know the KRG are very aware of the potential importance of tourism to Kurdistan and I am absolutely delighted to help open today's proceedings and hand over to the Minister who is going to give us all the information we need to encourage investment in tourism and hospitality!